1538806476 NPI number — KARA DIANA ATKINS PTA

Table of content: KARA DIANA ATKINS PTA (NPI 1538806476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538806476 NPI number — KARA DIANA ATKINS PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATKINS
Provider First Name:
KARA
Provider Middle Name:
DIANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KETCHNER
Provider Other First Name:
KARA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538806476
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 NE LOOP 820 BUSINESS TOWER 1, SUITE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-292-8787
Provider Business Mailing Address Fax Number:
817-789-6849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 BRIGGS ST STE 990
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78224-1287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-226-9536
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  PTA-014325 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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